Many of Sara Stephenson's friends are taken aback
when she tells them that her son will not be
circumcised after his birth next month. Some have
reminded her of an episode in the TV series "Sex and
the City" in which the female characters are repulsed
by the thought of having sex with an uncircumcised
man.

She wouldn't want that to happen to her son, would
she?

"I tell them it's just a TV show," said Stephenson,
34, of Chaska.

Still, this is just one of the many issues that
parents struggle with when they face the decision of
whether to circumcise their sons. Yes, there are some
minor health aspects to the decision, but experts say
there is no clear medical reason to remove the foreskin
of an infant's penis. The choice is largely driven by
cultural preference.

In the United States, most boy babies are
circumcised because most American men are. That, and
the fact that circumcision is usually paid for by
health insurance, is why the practice continues, said
Eli Coleman, a professor and director of the Program on Human Sexuality at the
University of Minnesota.

"We are all trying to look like a man ... is
supposed to," he said.

That's also why leaving their son uncircumcised is a
natural choice for Stephenson and her husband, Paul,
30. They're British. And in Great Britain, with the
exception of Jewish and Muslim religious practices,
boys aren't routinely circumcised. They haven't been
since the early 1950s, when the National
Health Service stopped paying for it.

"The treatment is cosmetic and totally unnecessary,"
said Paul Stephenson.

But that change in circumcision policy has prompted
many physicians to predict that private insurance won't
be far behind. Most private plans still cover routine
circumcision and have no plans to change, said health
plan officials. But "the writing is on the wall," said
Dr. John O'Connell, a pediatrician who practices at
clinics in Edina, Burnsville and Shakopee.

"We are concerned that this is not going to be
covered by commercial insurers as time goes on," said
Dr. Peter Dehnel, medical director for the Children's Physician Network, a
statewide organization of pediatric clinics.

So some clinics are preparing to do circumcisions in
the doctor's office, as opposed to hospital nurseries.
O'Connell said his clinics are planning to charge $300.
That way, parents who want the procedure but don't have
coverage will pay much less than it would cost in the
hospital, he said. Rates for circumcision vary,
hospital officials said, but would most likely cost
$700 or more if done in a hospital.

"That health plan thing is shocking to me," said Lee
Anne Swanson-Peet, 35, of St. Paul, who was attending a
recent prenatal class with the Stephensons at Abbott Northwestern Hospital in
Minneapolis. O'Connell, who gave a talk about infants
during the class, warned the group to check with their
health plans to make sure circumcision is covered.

Swanson-Peet said that if she has a boy he will be
circumcised, partly because she is Jewish. "But I would
do it anyway," she said, because she wants him to look
like his father, and because it's the norm in the
United States.

It's unclear if dropping circumcision from insurance
coverage would have an effect on its frequency.
HealthPartners tried that for a while in the mid-1980s,
and finally gave in to public and medical pressure and
started covering it again in the mid-1990s, said Dr.
George Isham, medical director of HealthPartners.

"That decision was based on the notion that this was
a patient dis-satisfier, and there was not a clear
consensus in the medical profession," he said.

It is, nonetheless, one of the few cosmetic
procedures that insurance does cover routinely, Isham
said. The only other one he could think of, he said,
was breast reconstruction after cancer surgery.

Although no one knows its origin, circumcision has
been around for thousands of years in many cultures.
Egyptian mummies have been found to be circumcised, and
wall paintings from that era depict ritual
circumcisions. It is an ancient ritual in both Muslim
and Jewish religions, but not generally associated with
Christian or Eastern religions.

Belief in its health benefits arose in the 19th
century. Doctors advised using circumcision as a
treatment for practices that were considered sexual
problems, such as masturbation. During World War II,
U.S. military personnel were circumcised as a way of
reducing sexually transmitted diseases.

In the mid-1970s, an estimated 80 percent of boys
were circumcised nationwide, but the number declined in
subsequent decades.

Rates are climbing again

Now, the number appears to be rising again. An
analysis of inpatient hospital data published in the
Journal of Urology in 2005 showed that
nationwide rates climbed from 48 percent between 1988
and 1991 to 61 percent by 2000.

But those percentages varied widely by geography. It
was highest in the Midwest and Northeast -- averaging
71 percent and 68.9 percent respectively, and lowest in
the West -- 28 percent. Most of the increase occurred
in the South, which averaged 53 percent, said Dr. Caleb
Nelson, lead author of the study and a pediatric
urologist at Children's Hospital in Boston. The
research does not explain why those changes occurred,
he said, but it may be linked to a population shift
from North to South during that period.

The Centers for Disease Control and Prevention
estimates that in 1999 the national average rate was 65
percent.

[CIRP Note: In 2004, the average rate
of non-therapeutic circumcision of newborn boys in the
United States was 55% and in a declining trend,
according to the National Inpatient Sample. This is the
lowest rate since approximately 1935.]

The practice persists despite the fact that leading
medical organizations have said
there is no clear medical benefit. And although
circumcision used to be done without local anesthesia,
that's no longer the case. With anesthesia, doctors say
that most babies appear to feel little discomfort.

It has, however, always been a contentious procedure
in medicine. And in 1999 the American
Academy of Pediatrics adopted a hands-off policy.
It says that doctors should provide parents with the
medical pros and cons -- and then let them decide.

"This is the perfect situation where you ought to
let people choose," said Isham.

And most parents choose circumcision because they
want their sons to look like their fathers, or because
they are worried that their sons might look different
than other boys, doctors say.

"It's not what the girls think, it's what the boys
will think," said Coleman. "It's that father and son
will go into the shower and be comparing their penises,
that this is what a good man looks like."

Some parents find that ridiculous.

"I remember telling one of my friends, 'If your
husband had blue eyes and your son had brown, would you
give him contacts?' "said Michelle Cunningham, 45, of
Minneapolis, who has two sons. "Why do their penises
have to match?"